Provider Demographics
NPI:1770015034
Name:BROKEN CHAINS CHRISTIAN COUNSELING,INC.
Entity Type:Organization
Organization Name:BROKEN CHAINS CHRISTIAN COUNSELING,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SONCRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LISAC
Authorized Official - Phone:602-377-8324
Mailing Address - Street 1:8998 W RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7980
Mailing Address - Country:US
Mailing Address - Phone:602-377-8324
Mailing Address - Fax:
Practice Address - Street 1:8998 W RUTH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7980
Practice Address - Country:US
Practice Address - Phone:602-377-8324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty